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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 407 -410. doi: 10.3877/cma.j.issn.1674-3253.2017.06.012

所属专题： 文献；

临床研究

腹腔镜下膀胱腰大肌悬吊输尿管再植术处理妇科输尿管损伤的初步研究
嵇福荣1, 蔡龙俊1, 晁流1, 刘高1, 张绍崎1, 张建军1, 孙永明1, 方先林1, 蔡维奇1,†()   
  1. 1. 223800　江苏，徐州医科大学附属南京鼓楼医院集团宿迁市人民医院泌尿外科
  • 收稿日期:2016-11-27 出版日期:2017-12-01
  • 通信作者: 蔡维奇
  • 基金资助:
    国家自然科学基金面上项目(81572512，81572519)

Laparoscopic ureteroneocystostomy with psoas hitch in the treatment of ureteral injuries after gynaecological surgeries

Furong Ji1, Longjun Cai1, Liu Chao1, Gao Liu1, Shaoqi Zhang1, Jianjun Zhang1, Yongming Sun1, Xianlin Fang1, Weiqi Cai1,†()   

  1. 1. Department of Urology, Affiliated Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Xuzhou Medical University, Jiangsu 223800, China
  • Received:2016-11-27 Published:2017-12-01
  • Corresponding author: Weiqi Cai
  • About author:
    Corresponding author: Cai Weiqi, Email:
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嵇福荣, 蔡龙俊, 晁流, 刘高, 张绍崎, 张建军, 孙永明, 方先林, 蔡维奇. 腹腔镜下膀胱腰大肌悬吊输尿管再植术处理妇科输尿管损伤的初步研究[J]. 中华腔镜泌尿外科杂志(电子版), 2017, 11(06): 407-410.

Furong Ji, Longjun Cai, Liu Chao, Gao Liu, Shaoqi Zhang, Jianjun Zhang, Yongming Sun, Xianlin Fang, Weiqi Cai. Laparoscopic ureteroneocystostomy with psoas hitch in the treatment of ureteral injuries after gynaecological surgeries[J]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(06): 407-410.

目的

评价腹腔镜下膀胱腰大肌悬吊输尿管膀胱再植术治疗妇科手术后输尿管远端损伤的有效性及安全性。

方法

回顾性分析了宿迁市人民医院于2013年6月至2016年6月间行腹腔镜下膀胱腰大肌悬吊输尿管膀胱再植术处理6例妇科手术术后输尿管远端损伤患者。其中患者平均年龄为48岁（24～65岁），左侧输尿管损伤4例，右侧输尿管损伤2例。输尿管损伤与修复之间的平均间隔时间为45 d（3～90 d），体质量指数为25 kg/m2（20～28 kg/m2），输尿管平均缺损长度为4 cm（3～7 cm）。

结果

所有患者手术均经腹腔镜顺利完成，无中转开放。平均手术时间为133 min （90～210 min），平均手术失血量是95 ml （70～150 ml）。术后平均住院8 d （5～11 d），平均随访时间17个月（6～26个月）。患者拔除尿管前均行膀胱造影检查，所有患者无吻合口渗漏。所有患者双J管留置时间均为6周。3个月随访IVU显示患者肾脏积水均部分缓解。

结论

腹腔镜下膀胱腰大肌悬吊输尿管膀胱再植术治疗妇科手术后输尿管远端损伤安全、有效，可以满足输尿管膀胱无张力吻合，短期随访效果满意。

关键词: 腹腔镜, 输尿管膀胱再植, 膀胱腰大肌悬吊, 输尿管损伤
Objective

To evaluate the efficacy and safety of laparoscopic ureteroneocystostomy with psoas hitch in the treatment of ureteral injuries after gynaecological surgeries.

Methods

The data of 6 patients, who underwent laparoscopic ureteroneocystostomy using the psoas hitch procedure for ureterovaginal fistulas following hysterectomy were reviewed retrospectively during June 2013 to June 2016. The patients had a mean age of 48 years (24-65 years) and a mean ureteral injuries of 4 cm (3-7 cm) in diameter. The mean interval between ureteral injury and repair was 45 days (3-90 days). Body mass index was 25 kg/m2 (20.4-27.6 kg/m2).

Results

Transperitoneal laparoscopic ureteroneocystostomy was performed in all cases. The mean operative time (ORT) was 133 min (90-210 min) and estimated blood loss (EBL) was 95 ml (70-150 ml). Average hospital stay was 8 days (5-11 days). Follow-up time was 17 months (6-26) months. The double J stent was removed after 6 weeks following repair in all patients. Three months after operation, IVU showed repaired moiety of all patients.

Conclusion

Laparoscopic ureteroneocystostomy with psoas hitch is safe for gynaecological surgeries ureteral injuries. And with less morbidity and quick convalescence. The short-term follow-up results were satisfactory.

Key words: Laparoscope, Ureteroneocystostomy, Psoas hitch, Ureteral injury
图2 患者拔除尿管前行膀胱造影检查，排除吻合口漏
视频1 腹腔镜下膀胱腰大肌悬吊输尿管再植术
[1]
Elliott SP, Mcaninch JW. Ureteral injuries: external and iatrogenic[J]. Urol Clin North Am, 2006, 33(1): 55-66
[2]
Moawad G, Astrid von Walter Gonzalez. Management of urinary tract injuries in minimally invasive gynecologic surgery[J]. Topics in Obstetrics & Gynecology, 2013, 33(3): 1-7.
[3]
王焕，王德娟，李文薇．膀胱镜检术在妇科腹腔镜手术输尿管损伤预防及早期诊断中的作用[J/CD]．中华腔镜泌尿外科杂志:电子版, 2013, 7(5): 384-386.
[4]
De Cicco C, Ussia A, Koninckx PR. Laparoscopic ureteral repair in gynaecological surgery[J]. Curr Opin Obstet Gynecol, 2011, 23(4): 296-300.
[5]
Manassero F, Mogorovich A, Fiorini G, et al. Ureteral reimplantation with psoas bladder hitch in adults: a contemporary series with long-term followup[J]. Scientific World Journal, 2012, 2012: 379316.
[6]
Koukouras D, Petsas T, Liatsikos E, et al. Percutaneous minimally invasive management of iatrogenic ureteral injuries[J]. J Endourol, 2010, 24(12): 1921-1927.
[7]
杨越波，曾海涛，陈静．妇科手术中泌尿系损伤9例临床分析[J/CD]．中华腔镜泌尿外科杂志:电子版, 2011, 5(6): 504-507.
[8]
邹建纲，陆曙炎，周忠兴，等．腹腔镜盆腔手术致泌尿系脏器损伤的防治[J]．中华腔镜泌尿外科杂志:电子版, 2010, 4(6): 498-500.
[9]
朵永福，刘国庆，张世林，等．输尿管镜和腹腔镜在治疗妇科手术致输尿管损伤的比较[J/CD]．中华腔镜泌尿外科杂志:电子版, 2015, 9(4): 295-297.
[10]
Juarez-Soto A, Arroyo-Maestre JM, Soto-Delgado M, et al. Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract[J]. Can Urol Assoc J, 2014, 8(5/6): E366-E370.
[11]
Modi P, Gupta R, Rizvi SJ. Laparoscopic ureteroneocystostomy and psoas hitch for post-hysterectomy ureterovaginal fistula[J]. J Urol, 2008, 180(2): 615-617.
[12]
Ghosh B, Biswal DK, Bera MK, et al. Laparoscopic extravesical Lich-Gregoir ureteroneocystostomy with psoas hitch for the management of ureterovaginal fistula in Post-Hysterectomy patients[J]. Urol Int, 2016, 96(2): 171-176.
[13]
Patil NN, Mottrie A, Sundaram B, et al. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation[J]. Urology, 2008, 72(1): 47-50.
[14]
Yang C, Jones L, Rivera ME, et al. Robotic-assisted ureteral reimplantation with Boari flap and psoas hitch: a single-institution experience[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(9): 829-833.
[15]
Kozinn SI, Canes D, Sorcini A, et al. Robotic versus open distal ureteral reconstruction and reimplantation for benign stricture disease[J]. J Endourol, 2012, 26(2): 147-151.
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